Designed for
Virgin Media
Employee
Medical Trust
Effective from 1 January 2017
Arranged and provided by
Welcome to the Virgin Media
Employee Medical Trust
These pages are designed to provide a
summary of the benefits payable under
the Virgin Media Employee Medical Trust
(the ‘trust’) and help explain the claiming
process to you.
If you still have any questions or queries after reading it,
simply call the helpline on 0800 389 0207†. Or, if you have
speech or hearing difficulties and use a textphone,
call 0345 606 6863.
†We may record or monitor our calls.
Help is just a phone call away
The trust has been set up by Virgin Media to provide you
with benefits. The trustees of the trust have appointed
Bupa Insurance Services Limited (Bupa) to help
administer the trust on their behalf. Where you see the
words ‘we/our/us’ in this summary it means Bupa acting
on behalf of the trustees.
We want you to use our expertise to help make life easier
for you in any way we can. One of the most direct ways we
can do this is through our telephone support.
Anytime HealthLine
Elderly Care Support Line
Whatever your health question or concern – from advice
about symptoms, to information on leading a healthier
lifestyle – you can speak to a nurse, 24 hours a day, seven
days a week.
If you’re thinking about elderly care for a loved one, we
have a dedicated support line to help you.
We’re on hand to offer free advice on many aspects of
elderly care – from financial worries, to finding a care
home, to support with illnesses such as dementia.
If you have a medical problem and you need more help a
GP will aim to call you back within the hour.
You can ask us questions about anyone in your family,
they don’t have to be on your policy.
For health advice
For elderly care advice
*Calls may be recorded and to maintain the quality of our
Bupa HealthLine service a nursing manager may monitor
some calls always respecting the confidentiality of the call.
†We may record or monitor our calls.
Call 0345
Call 0330
607 7777*
134 6696†
Lines are open 8am to 8pm Monday to Friday and 9am to
5pm on weekends.
These pages are for the Bupa Select scheme and only provide a brief summary of the benefits payable under the trust. Full details including the exclusions and benefit limits
are not set out on these pages. Further details are available from the helpline although you may need to refer to the trust rules for full details.
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Health information at
your fingertips
We have an A to Z of health
topics and tools that you and your
family can easily access online.
It’s our goal to provide you with
trusted information so you can
make the right decisions about
your health and wellbeing. Try our
tools and calculators to give you
an insight into your own health
Bupa.co.uk/health-information/
tools-calculators
Supporting you
when you need it most
Find the facilities and expertise you need
When you have a medical condition, speaking to someone
who understands can make a big difference. We have
specialist support teams in a range of key condition areas
offering you the help and advice you need, when you need
it most.
Our website is home to ‘Finder’ – an online resource that
brings together information on all our people and places.
You can use Finder to search for:
JJ
recognised consultants
JJ
therapists
JJ
recognised dentists
JJ
hospitals
JJ
health and dental centres
JJ
care homes
JJ
retirement housing.
Our specialist support teams are made up of advisers, care
coordinators and nurses. They’ll help with everything from
understanding your condition, to getting decisions on
drugs, to supporting you and your family emotionally.
Specialist support teams
JJ
JJ
JJ
JJ
JJ
JJ
JJ
Cardiovascular
Oncology
Mental health
Muscles, joints and bones
Gastroenterology
Eyecare or Ophthalmology
Obstetrics and gynaecology
Search online for our services
Visit finder.bupa.co.uk
How to access the team you need
When you call the helpline, you’ll be referred to the team
who specialises in your particular medical condition.
You’ll be able to call your team directly, Monday to Friday,
8am to 8pm and on Saturdays 8am to 4pm.
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Summary of benefits
The type of treatment payable under
the trust
Referral letter’ from your GP and call us before
arranging a consultation or receiving treatment.
We’ll confirm whether your proposed treatment
will be eligible under your benefits and, if so,
the medical and other health practitioners and
treatment facilities that you must use. Failure
to call us to obtain pre-authorisation for your
treatment means that you will be responsible for
paying for all such treatment.
The trust only pays benefits for eligible treatment.
By this we mean treatment of an acute condition
together with the products and equipment used
as part of the treatment that:
oo
are consistent with generally accepted
standards of medical practice and
representative of best practices in the
medical profession in the UK
oo
are clinically appropriate in terms of type,
frequency, extent, duration and the facility
or location where the services are provided
oo
are demonstrated through scientific
evidence to be effective in improving health
outcomes, and
oo
What is not payable under the trust
There are certain medical conditions and
treatments that benefits are not payable for or
are restricted for under the trust. There are some
exceptions to the exclusions too. Please refer to
your trust rules or call the helpline for more details.
The excluded or restricted medical conditions
and treatments include but are not limited to:
treatment for ageing, menopause and puberty;
AIDS/HIV; allergies; birth control, conception,
sexual problems or gender reassignments;
chronic conditions; complications from
excluded conditions; treatment resulting from
contamination, wars, riots or terrorist acts;
convalescence care, rehabilitation or general
nursing care; cosmetic, reconstructive or weight
loss treatment; treatment for deafness or to
correct eyesight; dental or oral treatment; dialysis;
experimental drugs and treatment; treatment
resulting from any pandemic; intensive care (other
than routinely needed after private day-patient
treatment or in–patient treatment); learning
difficulties, behavioural and developmental
problems; pregnancy and childbirth; screening
and preventive treatment; sleep problems and
disorders; speech disorders; remote consultations;
temporary relief of symptoms; out-patient drugs
and dressings; physical aids and appliances;
chronic mental health conditions; pre‑existing
conditions – if you are an underwritten beneficiary;
mental health treatment for or arising from
addictive conditions or problems, including but
not limited to alcoholism and drug addiction;
sexually transmitted diseases.
are not provided or used primarily for the
expediency of you or your consultant or
other healthcare professional
and the treatment, services or charges are not
excluded under the trust rules.
Treatment must, in most cases, follow an initial
referral by your GP. The consultant in overall
charge of your treatment must be a trust
recognised consultant.
Trust recognised practitioners
and facilities
The trust has adopted for its own use certain
medical and other health practitioners and
treatment facilities recognised by Bupa Insurance
Limited for the purpose of their health insurance
schemes.
Who you use can affect the level of benefits
payable under the trust. Also, they may only be
recognised by us for certain types of treatment
or levels of benefits. The type of treatment and/
or level of benefit that we recognise them for can
change from time to time.
The Open Referral service
The Open Referral Service applies to your benefits.
Your benefits, payable under the trust, depend
on you using certain trust recognised medical
practitioners and treatment facilities that we
specify for you when you call to pre-authorise
your treatment. You must ask for an ‘Open
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Summary of benefits table for
the Virgin Media Employee
Medical Trust
Benefits
Maximum benefit available
Notes
Finding out what is wrong and being treated as an out-patient
Out-patient consultations with a consultant
Out-patient therapies
with a trust recognised consultant we specify
up to £1,500 combined limit each year
Facility charges for out-patient diagnostic
tests on consultant referral
with a trust recognised therapist we specify
in a trust recognised facility we specify
Out-patient complementary medicine
up to £250 each year
with a trust recognised complementary medicine
practitioner (acupuncture, chiropractic and
osteopathy only) we specify
Out-patient MRI, CT and PET scans on
consultant referral
paid in full
in a trust recognised facility we specify
Consultants’ fees
paid in full
with a trust recognised partnership consultant and
in a trust recognised facility we specify
Parent accommodation
paid in full
one parent only, accompanying a child up to age 16
who is a beneficiary under the trust and receiving
eligible in-patient treatment in a trust recognised
facility we specify
Facility charges for surgical operations carried
out as out-patient treatment
paid in full
in a trust recognised facility we specify
Facility charges for day-patient treatment and
in-patient treatment
paid in full
in a trust recognised facility we specify
Being treated in hospital
Cancer treatment
Cancer cover - as for other treatment set out in this table except for:
Out-patient consultations with a consultant
paid in full
with a trust recognised consultant we specify
Out-patient therapies and complementary
medicine on GP or consultant referral
paid in full
with a trust recognised therapist or
complementary medicine practitioner
(acupuncture, chiropractic and osteopathy only)
we specify
Facility charges for out-patient diagnostic
tests on consultant referral
paid in full
in a trust recognised facility we specify
Facility charges for eligible out-patient cancer
drugs
paid in full
in a trust recognised facility we specify
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Benefits
Maximum benefit available
Notes
up to a maximum of 28 days each year
for day-patient treatment and in-patient treatment
combined and not individually
Mental health treatment
Mental health treatment
Please note we do not pay for mental health
treatment for, related to or arising from any addictive
condition including but not limited to substance or
solvent abuse, alcoholism or drug addiction, whether
or not related to prescription drugs.
Consultants’ fees, mental health and wellbeing
therapists’ fees and diagnostic tests for
out-patient mental health treatment
up to and from within your available
out-patient benefit limits above
with a trust recognised consultant or mental health
and wellbeing therapist we specify
Consultants’ fees for day-patient and
in-patient mental health treatment
paid in full
with a trust recognised partnership consultant and
in a trust recognised facility we specify
Facility charges for day-patient and in-patient
mental health treatment
paid in full
in a trust recognised facility we specify
Treatment at home
paid in full
for the charges that we have confirmed to pay on
your behalf and provided by a trust recognised
medical treatment provider
Home nursing
paid in full
when immediately following private eligible
in-patient treatment
Private ambulance charges
paid in full
when medically necessary and related to private
eligible day-patient or in-patient treatment
Additional benefits
Overseas emergency treatment
Please note: you will need to pay the medical providers in the country of treatment. On return to the UK submit the itemised and dated receipted
invoices to us for assessment.
Out-patient consultations, therapies,
diagnostic tests and complementary medicine
paid up to and from within your available
out-patient limit above
when temporarily travelling outside the UK
Out-patient MRI, CT and PET scans
up to £100 towards all the fees and charges and
not each charge individually
when temporarily travelling outside the UK
Consultants’ fees for out-patient surgical
operations, day-patient and in-patient treatment
paid up to the Bupa UK monetary limits that
apply for trust recognised consultants
when temporarily travelling outside the UK
Overseas facility charges for out-patient
surgical operations
up to £100 towards all the facility charges and
not each charge individually
when temporarily travelling outside the UK
Overseas facility charges for day-patient and
in-patient treatment
up to £200 each day towards all the facility
charges and not each charge individually
when temporarily travelling outside the UK
Your repatriation/evacuation
upon authorisation, paid in full
when arranged by a trust recognised medical
assistance company
Accompanying partner/relative during your
repatriation or evacuation
upon authorisation, up to £750 towards all
the costs
when arranged by a trust recognised medical
assistance company
NHS cash benefit for NHS in-patient treatment
£150 a night for up to 35 nights each year
for NHS in-patient treatment that would otherwise
be eligible for benefit under the trust
NHS cash benefit for NHS in-patient stays that
you receive radiotherapy, chemotherapy or a
surgical operation that is for cancer treatment
£100 each night
for NHS in-patient treatment for cancer treatment
that would otherwise be eligible for benefit under
the trust
NHS cash benefit for NHS out-patient or
day-patient treatment or NHS home treatment
for cancer
£100 for each day you receive radiotherapy in a
hospital setting
for eligible NHS out-patient or day-patient treatment
or NHS home treatment for cancer that would
otherwise be eligible for benefit under the trust
Repatriation and evacuation assistance
Cash benefits
£100 for each day you receive IV-chemotherapy
and for each three-weekly interval of oral
chemotherapy or part thereof
£100 on the day of your surgical operation
Excess
An excess amount of £50 or £100, whichever is applicable, applies to each beneficiary individually. The excess
applies each year to treatment costs for eligible treatment. You are responsible for paying the excess. Please call
the helpline to confirm the amount of the excess that applies to you, how the excess works and how it affects your
benefits payable under the trust.
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Claiming
Always call the helpline before arranging any consultations or treatment to check the benefits payable under the trust.
Also, should you have any queries about your treatment, we can offer you the opportunity to speak to a nurse working
in Bupa’s care management team.
A step-by-step guide to making a claim
STEP
1
Visit your GP
If you need to see a medical professional using your health trust, you are normally required to see your GP first.
However there are some conditions where a GP referral is not usually required. We have developed direct access*
pathways, in particular for muscle, joint or bone conditions, breast and bowel cancer symptoms and cataracts to provide
fast and convenient access to the expertise of therapists who specialise in these fields. Just call your Bupa helpline.
*Direct access telephone services are available as long as the symptoms are payable under the trust. Pre-existing and
chronic conditions are normally excluded. Direct access services may not be available for some underwriting
methods. Please call us to allow us to check your eligibility for the direct access service. Your out-patient allowance
will be used to fund treatment after your direct telephone consultation.
STEP
2
Ask for a referral letter
If you have a condition for which a GP referral to a consultant or healthcare professional is required, you must ask
your GP for an ‘Open Referral letter’ to ensure that your treatment is payable under your benefits. An Open Referral
letter will detail the care your GP would like you to have, but will not be addressed to a specific consultant, hospital
or healthcare professional.
An Open Referral letter needs to include your GP’s assessment of your symptoms, the body area affected and the
type of specialist your GP would like you to see. Alternatively, you can give your GP our simple Open Referral form to
complete as an alternative to a standard referral letter. A copy of the form can be found at: bupa.co.uk/referral
Important: you must call us to authorise any consultations or treatments. Failure to obtain pre-authorisation from us
means that you will be responsible for paying for all such consultations and treatments.
STEP
3
Call your bupa helpline before arranging a consultation or receiving treatment
As soon as you have seen your GP, please call us so that we can discuss your options and explain which
consultants and healthcare professionals are payable under your benefits. We will let you know what you need
to do next and send you any necessary claim or pre-treatment forms you may need to complete.
To help us to make the claims process as simple and swift as possible, please have the following information
close to hand when you call to make a claim:
oo
your Bupa registration number
oo
the condition you are suffering from
oo
details of the treatment that your GP has recommended
If you are an underwritten beneficiary of the trust we will also ask:
STEP
4
oo
for your registration number – as shown on your registration certificate.
oo
when did your symptoms first begin?
oo
when did you first see your GP about them?
Get a pre-authorisation number
When we have confirmed that your treatment is eligible under your benefits, we will discuss your claim with
you and give you a ‘pre-authorisation’ number. You can then contact your consultant or healthcare professional
to arrange an appointment. We recommend that you give your pre-authorisation number to the consultant or
healthcare professional you see so that the invoice for any treatment costs can be sent to us directly.
Please call us to authorise any further consultations or treatment to ensure that they are eligible under your benefits.
If for any reason you are sent the invoice, simply send it on to: Claims Department, Bupa, Salford Quays, M50 3XL
Once we have paid the invoice on your behalf, we will send you a summary of your claim and treatment details.
Please note that payment may take a few weeks depending on how quickly invoices are submitted to us.
For more details please call the helpline on
0800 389 0207†
†We may record or monitor our calls.
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Important information
The Virgin Media Employee Medical Trust is a trust that has been set up by Virgin Media to provide you with benefits.
Benefits are only payable under the trust if the trustees have sufficient funds to meet the cost of your claim.
These pages only contain a brief summary of the benefits payable under the trust. They do not set out full details of
what is or isn’t payable under the trust. The trust rules (which will override this summary in the event of inconsistencies)
may change from time to time, particularly on 1 January. Such changes could affect, for example the amount and type
of benefits payable and/or the exclusions set out in these summary pages. Full details of the trust rules are available on
request from the helpline.
Where we refer to an underwritten beneficiary we mean a beneficiary who as part of his/her application to join the trust
was required to provide details of his/her medical history to us for the purpose of underwriting.
If you are unsure, please call the helpline and they will confirm whether you are an underwritten beneficiary under this trust.
Privacy Notice
Our Privacy Notice explains how we take care of your personal information and how we use it to pay benefits under
the trust. A full version of the notice can be found in your trust guide or online at www.bupa.co.uk/privacy.
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Bupa Health Trusts are
administered by Bupa
Insurance Services Limited.
Registered in England and
Wales No. 3829851.
Registered office: Bupa House,
15-19 Bloomsbury Way, London
WC1A 2BA.
© Bupa 2017
bupa.co.uk
Virgin Media Employee Medical Trust (0064) – CMCT/7998/OR/Jan17
94448 UNI
www.bupa.co.uk